Laws against smoking in public places have been linked to lower hospitalizations for heart attacks, strokes and respiratory diseases. / Spencer Platt, Getty Images

by Liz Szabo, USA TODAY

by Liz Szabo, USA TODAY

Smoking bans quickly and dramatically cut the number of people hospitalized for heart attacks, strokes and respiratory diseases such as asthma and emphysema, an analysis out Monday shows.

Heart attack hospitalizations fell an average of 15% after communities passed laws banning smoking in areas such as restaurants, bars and workplaces, according to the largest analysis of smoke-free legislation to date. The analysis included 45 studies covering 33 laws in American cities and states, as well as countries such as New Zealand and Germany.

Stroke hospitalizations fell 16%, while hospitalizations for respiratory disease fell 24%, according to the study, published Monday in Circulation.

The more comprehensive the law, the greater the impact, says senior author Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California-San Francisco.

For example, a 2002 law banning smoking only in restaurants in Olmsted County, Minn., had no effect on heart attacks, according to a study also published Monday in the Archives of Internal Medicine. However, hearts attacks fell by 33% after a 2007 law that expanded the smoking ban to all workplaces, including bars, according to the report, from Minnesota's Mayo Clinic.

That drop is especially impressive, given that people in Minnesota got less healthy in the same time, with higher rates of diabetes and obesity. Rates of high blood pressure and unhealthy cholesterol levels stayed the same.

Glantz says state lawmakers should consider these findings when voting to exempt certain facilities, such as bars or casinos, from smoke-free laws. "The politicians who put those exemptions in are condemning people to be put into the emergency room," Glantz says.

David Sutton, a spokesman for Philip Morris USA, the country's leading cigarette maker, says his company agrees that secondhand smoke is dangerous, but he says smoking bans aren't always necessary, and that businesses such as restaurants can accommodate non-smokers through separate rooms or ventilation.

"Reasonable ways exist to respect the comfort and choices of both non-smoking and smoking adults," Sutton says. "Business owners -- particularly owners of restaurants and bars -- are most familiar with how to accommodate the needs of their patrons and should have the opportunity and flexibility to determine their own smoking policy. The public can then choose whether or not to frequent places where smoking is permitted."

Neither report provides information about why smoking bans reduce heart attacks. But Glantz says smoke-free laws tend to lead people to smoke less or quit altogether.

Fewer people smoked at home, as well. The percentage of smoke-free homes in the state grew from 64.5% in 1999 to 87.2% in 2010, a period in which state and federal taxes also rose significantly, the Mayo study shows.

Smoking bans also protect non-smokers, says cardiologist Raymond Gibbons, past president of the American Heart Association, who was not involved in either study. Cigarette smoke can trigger heart attacks in non-smokers with underlying heart disease, he says.

â??Secondhand smoke affects a non-smoker's blood vessels in as little as five minutes, causing changes that increase the risk of heart attack, according to the Mayo Clinic study. About 46,000 non-smoking Americans die from secondhand smoke exposure each year, according to the National Cancer Institute.

Smoking bans also reduce health care costs -- for individuals, health plans and government payers, Glantz says. Total savings ranged from $302,000 in all health care costs in Starkville, Miss., to nearly $7 million just in heart attack-related hospitalizations in Germany, according to the Circulation study.

"If politicians are serious about cutting medical costs, they need to look at this," Glantz says. "The best way to keep health care costs down is to not get sick. ... There is nothing else you can do to have these big an effect on hospital admissions."